Persons with mental disorders and assisted dying practices in Spain: An overview.

On 25 June 2021, the Law on Euthanasia in Spain came into force, providing for two modes of helping an individual end their life: euthanasia and/or medically assisted suicide. Among the requisites that a request for euthanasia has to fulfil are that the individual must be suffering a severe, chronic and debilitating condition or a severe and incurable disease, at the same time as that person shows the necessary competence to decide. The possibility exists that a patient suffering mental health problems submits such a request; however, the specific characteristics of a mental health disorder make such a request considerably more complex. In this article, based on a narrative review of the law itself and the related literature, the requisites established under the law are analysed from an ethical-legal perspective with the aim of defining when a request for euthanasia from a person with a mental health disorder may be deemed legitimate and in line with legal provisions. This should help clinicians make rational, reasoned decisions when dealing with a request of this type.

Validation of "the patient evaluation of emotional care during hospitalisation" questionnaire in intensive care unit patients.

OBJECTIVE: To validate the "Patient Evaluation of Emotional Care During Hospitalization" (PEECH) questionnaire, which assesses hospitalised patients' emotional experiences, in patients admitted to the intensive care unit (ICU). INTERVENTIONS: Prospective study. The PEECH consists of three sections and four sub-scales: "level of security", "level of knowing", "level of personal value", and "level of connection". The questionnaire was completed by 253 hospitalised patients. Expert judgement was used to analyse the content validity and factor analysis was performed to confirm construct validity. Cronbach's alpha was used to measure the internal consistency of the four sub-scales. RESULTS: In the confirmatory factor analysis of the four sub-scales, the weights of all questions were found to be significant (>1). The internal consistency of the PEECH questionnaire was 0.86 (Cronbach's alpha) and the homogeneity index was high (>0.50). CONCLUSION: The PEECH questionnaire is a valid and reliable tool to evaluate the perception of emotional care in ICU patients. The information gathered can help provide more comprehensive care for patients in the ICU and in other hospitalised patients.

Aspectos éticos en la relación materno-infantil / Ethical aspects in the mother-child relationship

En las tres secciones que componen este artículo se explicitan aquellos aspectos éticos que son cruciales para acompañar en el establecimiento de una buena relación materno-infantil. En la primera sección se diferencia entre ética y moral. El vínculo materno-infantil, más allá del meramente biológico, contiene elementos culturales y morales. Al vivir en sociedades multiculturales y moralmente plurales, y al estar la crianza expuesta a modas, tradiciones y nuevas evidencias, la ética establece criterios que permiten esquivar el relativismo. La segunda sección se centra en la categoría del reconocimiento, clave en el desarrollo saludable de la persona. La autonomía, valor fundamental en ese desarrollo, bebe de fuentes sociales y de las esferas del amor, la justicia y la solidaridad. La tercera sección trata del rol de los profesionales para que su intervención genere participación, serenidad, capacidades y vínculos, todos ellos condiciones trascendentales en la búsqueda de una vida “apropiada”. (AU)

In the three sections that make up this article, those ethical aspects that are crucial to accompany the establishment of a good mother-child relationship are made explicit. In the first section a difference is made between ethics and morals. The mother-child bond, beyond the merely biological, contains cultural and moral elements. By living in multicultural and morally plural societies, and, as a child's upbringing is exposed to fashions, traditions and new evidence, ethics establishes criteria that allow us to avoid relativism. The second section focuses on the category of recognition, key in the healthy development of the person. Autonomy, a fundamental value in this development, draws from social sources and from the spheres of love, justice, and solidarity. The third section deals with the role of professionals so that their intervention generates participation, serenity, capabilities and bonds, all of them transcendental conditions in the search for an appropriate and own life. (AU)

El acceso parental a las Unidades de Cuidados Intensivos Neonatales en tiempos de pandemia / Parental Access to Neonatal Intensive Care Units in times of pandemic / L'accés parental a les Unitats de Cures Intensives Neonatals en temps de pandemia

La llegada de la pandemia por coronavirus SARS-CoV-2 (la enfermedad de la COVID-19) a España también ha repercutido en el acceso parental a las Unidades de Cuidados Intensivos Neonatales (UCIN). Al comienzo de la pandemia se tomaron las medidas que, fundamentadas en criterios de salud pública, se consideraron necesarias. A medida que avanzaba el conocimiento científico sobre la COVID-19, y en base a los nuevos datos obtenidos, se comenzaron a adaptar las medidas inicialmente establecidas. Sin embargo, creemos que la adaptación de alguno de estos protocolos, en concreto el del acceso parental a las UCIN, no ha sido la idónea desde el punto de vista bioético y del interés superior del menor. A lo largo de este artículo exponemos esas insuficiencias

The arrival of the SARS-CoV-2 coronavirus pandemic (COVID-19 disease) in Spain has also had an impact on parental access to Neonatal Intensive Care Units (NICU). At the beginning of the pandemic, measures were taken that, based on public health criteria, and were considered necessary. As scientific knowledge about COVID-19 advanced, and based on the new data obtained, the measures initially established began to be adapted. However, we believe that the adaptation of some of these protocols, specifically that of parental access to NICU, has not been the ideal one from the bioethical point of view and in the best interest of the minor. Throughout this article we expose these insufficiencies

L'arribada de la pandèmia per coronavirus SARS-CoV-2 (la malaltia de la COVID-19) a Espanya també ha repercutit en l'accés parental a les Unitats de Cures Intensives Neonatals (UCIN). A l'inici de la pandèmia es van prendre les mesures que, fonamentades en criteris de salut pública, es van considerar necessàries. A mesura que avançava el coneixement científic sobre la COVID-19, I en base a les noves dades obtingudes, es van començar a adaptar, les mesures inicialment establertes. No obstant això, creiem que l'adaptació d'algun d'aquests protocols, en concret el de l'accés parental a les UCIN, no ha estat la idònia des del punt de vista bioètic I de l'interès superior del menor. Al llarg d'aquest article exposem aquestes insuficiències

Sobre las definiciones de ética, legislación y deontología / About the definitions of ethics, legislation and deontology

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Hygea y la virtud o recordando a Protágoras: diálogo sobre ética de la salud comunitaria. Informe SESPAS 2018 / Hygeia and virtue or remembering Protagoras: dialogue on community health ethics. SESPAS Report 2018

Conversación entre la ética y la salud pública sobre las implicaciones morales de la promoción de la salud comunitaria, en la que se destaca la importancia de respetar la autonomía y de contribuir al empoderamiento de la comunidad con la que se colabora, además de la conveniencia de establecer un compromiso explícito en el que consten los límites de la colaboración y de la oportunidad de una deontología específica

A dialogue between ethics and public health on the moral implications of the promotion of community health in which the importance of respecting autonomy and contributing to the empowerment of the community with which it collaborates is highlighted; in addition to the appropriateness of an explicit commitment that sets out the limits of collaboration and the opportunity for a specific deontology

[Hygeia and virtue or remembering Protagoras: dialogue on community health ethics. SESPAS Report 2018]. / Hygea y la virtud o recordando a Protágoras: diálogo sobre ética de la salud comunitaria. Informe SESPAS 2018.

A dialogue between ethics and public health on the moral implications of the promotion of community health in which the importance of respecting autonomy and contributing to the empowerment of the community with which it collaborates is highlighted; in addition to the appropriateness of an explicit commitment that sets out the limits of collaboration and the opportunity for a specific deontology.

Towards public health ethics.

Health is a value, both objective and subjective, yet it is not the only value that contributes to the well-being of persons. In public health, there are different connotations of the term "public" relevant from an ethical perspective: population, government action, and collective action of the community. Ethics seeks to provide a basis for and justify moral decisions and actions. Ethics asks, why should I do it?, and the reply consists of an argument. The type of ethics that underpins applied ethics in general, and bioethics in particular, is civic ethics, a philosophical reflection on the criteria that enable the peaceful coexistence of citizens with different morals. Progress means emancipation as well as an increase of autonomy. However, more is not always better, and now we know that no health intervention, including a public health intervention, is risk-free. The false belief that undergoing a prevention intervention is always better than doing nothing explains, at least in part, that in contrast to bioethics, only recently have the ethical implications in public health practice been given the attention they deserve. Positive externalities in third parties, such as in vaccination programmes or policies to prevent harm to passive smokers, can occasionally justify the potential risks of a public health intervention. It is in such situations where a conflict might arise between the goal of improving the health of the population and the respect for the rights and freedoms of the individual that characterizes the dilemmas in public health ethics. In conclusion, it is necessary to have a public health ethics framework and a professional code of ethics applied to public health. The training of public health professionals in ethics is essential to ensure that they feel more confident when it comes to addressing the sheer range of ethical conflicts that they frequently face in the performance of their duties.

Las voluntades anticipadas en pacientes con esquizofrenia: un instrumento para potenciar la autonomía / Advance Directives on Patients with Schizophrenia: A Tool for Maximize Autonomy

En este artículo pretendemos analizar la cuestión referente al documento de voluntades anticipadas (DVA), aunque no el vinculado con el final de la vida, sino durante la vida y en un contexto psiquiátrico como es el caso de la esquizofrenia. Para ello, en primer lugar esbozamos cuáles son las características básicas del DVA. En segundo lugar, y dado que lo centraremos en la enfermedad mental, comparamos el DVA con el documento de voluntades anticipadas psiquiátricas (DVAP) viendo son sus parecidos y diferencias. También, desarrollamos cuál es el contenido y la utilidad del DVAP. Por último, realizamos algunas críticas a ambos documentos (AU)

In this paper we pretend to analyze the question referent to advance directives, although not in the end of life, but both during the life and in psychiatric context as schizophrenia First, we describe what the basic features of the advance directives are. Second, as we wish to focus in the mental illness, we compare the advance directives with advance directives in psychiatry and we expose the differences and similarities. Also, we develop which is the content and utility of advance directives. Finally, we make a critical assessment of the advance directives (AU)

Para la humanización de la atención sanitaria: los cuidados paliativos como modelo / For the humanization of health care: palliative care as a model

Dos son los objetivos que se proponen en este artículo y que se corresponden con las 2 primeras de las 3 partes en las que se divide: el primer objetivo consiste en denunciar la deshumanización que se ha ido instalando, casi sin mucha consciencia por parte de los profesionales, en la atención sanitaria y se propone su humanización como una meta regulativa hacia la cual siempre hay que tender para no desviarse del núcleo de las profesiones de la salud que es atender a las personas. El segundo objetivo es dar 10 razones de por qué los cuidados paliativos son un buen modelo referente para la humanización de la asistencia sanitaria. El artículo concluye con unas consideraciones finales sobre algunas dificultades para ello (AU)

There are two objectives proposed in this article and are discussed in the first two of the three parts into which it is divided: the first objective is to mention the de-humanisation that has been installed, almost without much awareness by the healthcare professionals, and proposes its humanisation as a regulatory goal, towards which we must always try not to deviate from, as well as the main aims of the health professions, which are to serve people. The second objective is to present ten reasons why palliative care is a good reference model for the humanisation of healthcare. The article concludes with some final considerations on some difficulties in achieving this (AU)